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Mittelschmerz
middle pain
Done by: Mohammed Qazzaz
Definition
Mittelschmerz is one-sided, lower
abdominal pain associated with
ovulation. "Mittelschmerz" is a
German word that means "middle
pain." The condition occurs midway
through a menstrual cycle — about
14 days before your next menstrual
period.
In most cases, mittelschmerz doesn't
require medical attention. For minor
mittelschmerz discomfort, over-thecounter pain relievers and home
remedies are often effective.
If your mittelschmerz pain is
troublesome, oral contraceptive stop
ovulation and prevent midcycle pain.
Mittelschmerz pain usually lasts a few minutes
to a few hours, but it may continue for as long
as a day or two. Pain from mittelschmerz may
be:

On one side of your lower abdomen
Dull and cramp-like
Sharp and sudden
Accompanied by mild vaginal bleeding or
discharge
Rarely, severe
Mittelschmerz pain occurs on the side of the
ovary that's ovulating — releasing an egg —
in that menstrual cycle.
The pain may switch sides every other
month, but women may feel pain on the
same side for several months in a row.
For the patient:
Keep track of your menstrual cycle for
several months and note when you
experience lower abdominal pain. If it occurs
midcycle and goes away without treatment,
it's most likely mittelschmerz.
When to see a doctor
In the vast majority of cases,
mittelschmerz requires no medical
intervention. However, contact your
doctor if a new pelvic pain becomes
severe, if it's accompanied by nausea or
fever, or if it persists — any of which
could indicate you have a condition more
serious than mittelschmerz, such as
appendicitis pelvic inflammatory disease
or even an ectopic pregnancy
How this happen
During your menstrual cycle, the female sex
hormone estrogen causes the uterine lining
to thicken every month to create a
nourishing environment for a fertilized egg.
Soon afterward, a follicle — a tiny sac in the
ovary that contains a single egg — ruptures
and releases its egg (ovulation).
If the egg becomes fertilized on its way to
uterus by contact with a sperm, the egg
implants in the lining of the uterus. However,
most often the unfertilized egg passes
through uterus and out of your body. Shortly
thereafter, your uterus releases this lining
and the menstrual flow begins.
Mittelschmerz occurs during ovulation,
when the follicle ruptures and releases its
egg. It's estimated that 1 in 5 women
experience ovulation discomfort. Some
have mittelschmerz every month, while
others have it only occasionally.
The exact cause of mittelschmerz is
unknown, but possible reasons for the pain
include these:
•Just before an egg is released with
ovulation, follicle growth stretches the
surface of your ovary, causing pain.

•Blood or fluid released from the ruptured
follicle irritates the lining of your abdomen
(peritoneum), leading to pain.
Pain at any other point in menstrual cycle
isn't mittelschmerz.
It may be normal menstrual cramping
(dysmenorrhea) if it occurs during the
period, or it may be from other abdominal
or pelvic problems.

If your pain is severe during the time of
ovulation or at any other time during your
cycle, see your doctor.
What could be the others causes?
UPPER ABDOMINAL PAIN SYNDROMES

Biliary disease
Acute pancreatitis
Dyspepsia
Hiatus hernia
Pneumonia
Myocardial infarction
Splenic abscess or infarction
LOWER ABDOMINAL PAIN SYNDROMES
Appendicitis
Diverticular disease
Kidney stones
Bladder distension
Pelvic pain
DIFFUSE ABDOMINAL PAIN SYNDROMES
Mesenteric ischemia and infarction
Ruptured aneurysm
Peritonitis
Intestinal obstruction
ABDOMINAL PAIN IN FEMALES
- Pelvic inflammatory disease
- Adnexal pathology
- Endometriosis
- Ectopic pregnancy
- Endometritis
- Leiomyomas
If you need relief from the discomfort of
mittelschmerz, try an over-the-counter pain
reliever, such as acetaminophen (Tylenol,
others), aspirin, ibuprofen (Advil, Motrin,
others) or naproxen (Aleve).
If you experience mittelschmerz nearly every
month and it causes you quite a bit of
discomfort, talk to your doctor about the option
of taking a birth control pill (oral contraceptive).
Birth control pills prevent ovulation, which
prevents mittelschmerz because the condition
can only occur if an ovary releases an egg
Lifestyle and home remedies
If the discomfort from mittelschmerz lasts
more than a few minutes, try some home
remedies to gain relief. Because heat
increases blood flow, relaxes tense muscles
and eases cramping, you might want to try:
Soaking in a hot bath
Using a heating pad on the side of your
abdomen where the pain occurs
Reference: mayo clinic web site

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Mid cycle pain

  • 2. Definition Mittelschmerz is one-sided, lower abdominal pain associated with ovulation. "Mittelschmerz" is a German word that means "middle pain." The condition occurs midway through a menstrual cycle — about 14 days before your next menstrual period.
  • 3. In most cases, mittelschmerz doesn't require medical attention. For minor mittelschmerz discomfort, over-thecounter pain relievers and home remedies are often effective. If your mittelschmerz pain is troublesome, oral contraceptive stop ovulation and prevent midcycle pain.
  • 4. Mittelschmerz pain usually lasts a few minutes to a few hours, but it may continue for as long as a day or two. Pain from mittelschmerz may be: On one side of your lower abdomen Dull and cramp-like Sharp and sudden Accompanied by mild vaginal bleeding or discharge Rarely, severe
  • 5. Mittelschmerz pain occurs on the side of the ovary that's ovulating — releasing an egg — in that menstrual cycle. The pain may switch sides every other month, but women may feel pain on the same side for several months in a row.
  • 6. For the patient: Keep track of your menstrual cycle for several months and note when you experience lower abdominal pain. If it occurs midcycle and goes away without treatment, it's most likely mittelschmerz.
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  • 8. When to see a doctor In the vast majority of cases, mittelschmerz requires no medical intervention. However, contact your doctor if a new pelvic pain becomes severe, if it's accompanied by nausea or fever, or if it persists — any of which could indicate you have a condition more serious than mittelschmerz, such as appendicitis pelvic inflammatory disease or even an ectopic pregnancy
  • 9. How this happen During your menstrual cycle, the female sex hormone estrogen causes the uterine lining to thicken every month to create a nourishing environment for a fertilized egg. Soon afterward, a follicle — a tiny sac in the ovary that contains a single egg — ruptures and releases its egg (ovulation).
  • 10. If the egg becomes fertilized on its way to uterus by contact with a sperm, the egg implants in the lining of the uterus. However, most often the unfertilized egg passes through uterus and out of your body. Shortly thereafter, your uterus releases this lining and the menstrual flow begins.
  • 11. Mittelschmerz occurs during ovulation, when the follicle ruptures and releases its egg. It's estimated that 1 in 5 women experience ovulation discomfort. Some have mittelschmerz every month, while others have it only occasionally.
  • 12. The exact cause of mittelschmerz is unknown, but possible reasons for the pain include these: •Just before an egg is released with ovulation, follicle growth stretches the surface of your ovary, causing pain. •Blood or fluid released from the ruptured follicle irritates the lining of your abdomen (peritoneum), leading to pain.
  • 13. Pain at any other point in menstrual cycle isn't mittelschmerz. It may be normal menstrual cramping (dysmenorrhea) if it occurs during the period, or it may be from other abdominal or pelvic problems. If your pain is severe during the time of ovulation or at any other time during your cycle, see your doctor.
  • 14. What could be the others causes? UPPER ABDOMINAL PAIN SYNDROMES Biliary disease Acute pancreatitis Dyspepsia Hiatus hernia Pneumonia Myocardial infarction Splenic abscess or infarction
  • 15. LOWER ABDOMINAL PAIN SYNDROMES Appendicitis Diverticular disease Kidney stones Bladder distension Pelvic pain
  • 16. DIFFUSE ABDOMINAL PAIN SYNDROMES Mesenteric ischemia and infarction Ruptured aneurysm Peritonitis Intestinal obstruction
  • 17. ABDOMINAL PAIN IN FEMALES - Pelvic inflammatory disease - Adnexal pathology - Endometriosis - Ectopic pregnancy - Endometritis - Leiomyomas
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  • 19. If you need relief from the discomfort of mittelschmerz, try an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve).
  • 20. If you experience mittelschmerz nearly every month and it causes you quite a bit of discomfort, talk to your doctor about the option of taking a birth control pill (oral contraceptive). Birth control pills prevent ovulation, which prevents mittelschmerz because the condition can only occur if an ovary releases an egg
  • 21. Lifestyle and home remedies If the discomfort from mittelschmerz lasts more than a few minutes, try some home remedies to gain relief. Because heat increases blood flow, relaxes tense muscles and eases cramping, you might want to try: Soaking in a hot bath Using a heating pad on the side of your abdomen where the pain occurs
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